Covid19 initiative supporting NHS frontline workers

Covid19 amazing initiative supporting our frontline NHS workers during the Coronavirus crisis. Inspired by my friend Anthea Allen, Senior Sister in Critial Care at St George’s hospital; 2 friends of mine Janneke and Niall, set up this amazing initiative. Getting together a group of local volunteers to run meals direct to front line workers in ICU, numerous wards, A&E and paramedics 3 times a day.  These front line staff were struggling to access meals when at work at the hospital.

The volunteers have worked with local business and restaurants willing to offer healthy meals at hugely discounted price. This food has been delivered to St Georges Hospital every day at lunchtime, early evening and night, to feed front line staff on all their shifts.

It has been such a morale boost for everyone. This initiative is helping local businesses and looking after these incredibly brave and dedicated staff at the same time.

Currently delivering 200 freshly prepared and cooked meals direct to the front line NHS workers 3 times a day. Deliveries are undertaken by a team of local volunteers, who drive to the donating restaurants, collect and load the food and take it straight to the hospital whilst still hot. Medical Students meet the vehicles and take the food straight to the staff on the wards, Critical Care Units and A&E.

The businesses are delighted to help and have gone the extra mile, personally decorating cupcakes with special morale boosting messages and popping in extra treats to show their appreciation for everything the staff are doing.

In addition, the charity have used funds raised, to buy essential PPE, in particular goggles for front line staff. To ensure they received them as quickly as possible before more of them were put at risk. They also donated 10 ipads to enable conscious patients to communicate directly with their relatives as they are necessarily in hospital without visitors.

The charity founders are currently looking at collaborating with other similar operations set up to support other London hospitals.

Please share this with anyone who can support us and send donations to this link:

Covid19 amazing initiative supporting our frontline NHS workers, please support them if you can

https://www.paypal.com/pools/c/8nvYv7w5NH .

Follow @CriticalNhs for regular updates.

 

Supporting our front line workers

 

CriticalNHS First Aid for Life

The heartfelt plea from my friend Anthea, a Senior Sister on CCU – which triggered this initiative:

Covid19 initiative supporting our frontline NHS workers

I am a Senior Sister on Critical Care at St Georges Hospital. The hospital is in crisis- our executive staff are being amazing and the front line staff incredible. My nursing colleagues expose themselves daily to the the threat of Covid 19.The hospital are doing all they can to protect the staff with PPE training to safely care for all patients.We are opening other areas within the hospital to nurse critically ill patients in and employing agency staff to help out. We continue to receive trauma patients and those suffering from other medical or surgical issues through accident, illness or surgery.I am proud of my colleagues.

The nurses are stretched to the limit anyway but now are under immense pressure. I have seen tears, fear and exhaustion and last week some of the shops within St Georges refused to sell food, drinks & snacks to staff in scrubs or uniforms so staff missed meals. Supplies have been stolen and the hospital are working hard to put additional measures in place.

Please remember to spare a thought for the nurses who directly care for the patients and families on Critical Care and the dedicated wards in very difficult circumstances, frequently without appreciation, working long hours, skipping breaks and going the extra mile to ensure patients feel safe and well cared for. All while wearing cumbersome protective gear.

On Friday a friend of mine dropped off a huge box of doughnuts for the nurses on my unit that I took to work. They were so appreciated and within an hour were gone!.

Please note. It doesn’t matter how many ventilators we make, we need the skilled Critical Care nurses to operate them. Most doctors cannot operate a ventilator…Keep safe, wash your hands and remember- nurses are amazing.

 

Supporting our front line workers

 

An update from Anthea:

To all my friends, friends of friends, neighbours and this community.
I have been overwhelmed and amazed by the incredible generosity shown to my colleagues and myself since I sent my first email. I had hoped to gain some biscuits and possibly a homemade cake to share with my colleagues.
BUT…I did not expect this response.
The support has been beyond incredible. I have so far received a total of 9 bin bags packed with biscuits, chocolate, cake, biscuits and cereal bars. My staff have been fed with pizza, curry, Mediterranean fare, homemade cookies, brownies, homemade bread, cheese, doughnuts and huge baskets of fresh fruit.
I have received cards, emails and messages of support.
Friends have given me a lift to work. Each day there is more. Last night I arrived home beyond exhausted and there was a tin of homemade chocolate brownies sitting on the doorstep – there was a card saying “thank you nurses” I have no idea who made them but thank you.
The local school have emailed me offering support and to arrange food deliveries of sandwiches.
The heart warming kindness of strangers and the warm spirit of local people and my very dear friends and those further afield has warmed my heart.
Local friends have set up a funding page which has raised over £7000 in 2 days.

I have no words to express my gratitude.

The staff of Critical Care who are working tirelessly have been kept afloat by this support. They no longer have to bring their meals to work. Food is shared with other Covid19 wards.
Everyone is trained and competent in strict infection control procedure and the “donning and doffing” of PPE (personal protective equipment). All are trained to care for Covid patients who are strictly cohorted together being cared for by a team of Critical Care trained and experienced nurses, supported by ward nurses and student nurses. The team of doctors, nurses, physiotherapists and other healthcare professionals are working long hours with these patients and we also have our usual non Covid Critically ill patients.

The entire Trust are being incredible, Doctors, nurses, reception staff, ward clerks, porters, cleaners, security, nurse educators, technicians, lab workers, blood bank staff, pharmacists, dietitians and many others who help in keeping the big ship St Georges afloat.

I am proud to work for our NHS and please do not underestimate how much your kindness and generosity means to us all.
As one nurse said
“We are like the band in the Titanic film- we keep on playing while the ship goes down”
This ship will not sink and we will keep on keeping on.
Thank you, thank you, thank you.
Stay at home, wash your hands and be kind to each other.
Staff are working hard and are greatly affected emotionally by this crisis but I have seen much laughing and chatting among my colleagues while they are munching on pizza!
If you would like to contribute financially to a fund to help feed and support the nurses on Critical Care at St Georges my amazing friends have set up.

A further update from Anthea – Senior Sister on Critical Care – Covid19 initiative supporting our frontline NHS workers

The ongoing support that has overwhelmed me when I first made a request for biscuits has continued. @CriticalNhs (follow on Twitter)has been set up and run like a business – an efficient, well run, immediate response business started by Janneke & Niall who I am proud and honoured to call my friends. This has exploded.

I think you guys should run the NHS!

We needed biscuits and from that came delicious meals 3 times a day for my Critical Care team and other areas of the hospital. We have PPE top ups, fresh fruit & veg, spaghetti – scooped up fast by our Italian nurses, radios, chocolate, bespoke name badges, cake, hand cream, free parking at the hospital for staff, tablets for the patients to communicate with and one night fresh green leaves were delivered for one of our nurses rabbits.

The compassion shown by individuals has been outstanding. The clapping, the rainbows and for me – I appreciate every single email, text and message of support and the gifts & donations that end up on my doorstep!

I have been a nurse for 25 years. 23 of those in Critical Care and I thought I had seen everything.

Critical Care has changed over night. It’s like being in a sci fi movie – staff gowned up with visors, masks & head covers. Our usual capacity of ventilated beds has increased into wards, operating theatres & anaesthetic rooms. From 3 Critical Care units with a total of 30 beds, we now have 147 Critical Care beds in 7 areas. Highly trained nurses who usually care for one intensive care patient now have 3-4 patients, with helpers who are ward nurses and many have never before set foot on an intensive care unit- It’s a different environment- in a different world. This is before we escalate into Excel.

It’s tough. It’s hard, it’s claustrophobic in the gowns, masks & visors. Nurses are thirsty, enclosed in a room for 12 hours who’s only escape is to eat or visit the toilet. I saw one of my friends with blood on her scrubs as she had no time to change her tampon.

It’s raw and real and a halloumi wrap, pizza, curry or chocolate brownie is helping us through this tsunami.

I speak on behalf of nurses as I am one but we could not survive without doctors, porters, clerical staff, technicians, physios, dietitions, cleaners, lab staff, engineers, security and the fabulous volunteers who’s step count exceeds 20,000 steps a day. The NHS staff work tirelessly, abandoning their days off and giving all that they have.

We also have our usual Critical Care patients. Accidents, illness, cardiac arrests still happen and people still stab and harm each other despite the world being in crisis.

I have mopped up tears & cuddled nurses and passed chocolate around- limited social distancing in the hospital. Many of our nurses are from Europe or Ireland and miss their family. As part of my usual role is nurse recruitment, I get to know the nurses well and the younger ones call me “Mama Anthea”  I have become a temporary parent to some of our young nurses. I am also proud to have recruited my daughter Claudia as our new ward clerk until she can return to uni in Bristol.

It’s tough for us but tougher for the patients who have no visitors & are scared of this unknown & vicious virus.

Thank you for caring for us. We will keep on keeping on. The “keep calm and carry on” slogan from the 1940’s rings true.

Keep clapping, put rainbows in your window and stay at home.

My thanks on behalf of a truly fabulous group of people

NURSES!

If you want to help CriticalNhs who provide meals and many other items to support the staff at St Georges.

This is the link.

https://paypal.me/pools/campaign/113431121376689453

Further update from Anthea on Sunday 12th April – Covid19 initiative supporting our frontline NHS workers

I have always been a chatty person. It takes a lot to take my breath away. There are no words to describe the scenes and way of working within our forever expanding Critical Care.

ICU nurses are meticulous. Attention to detail is high on our list. I have many friends who carefully label the jars in their larder as we are so conditioned to labelling drugs and equipment to ensure we are alert to expiry dates or what a specific drug is and it’s dose. ICU nurses love to label.We keep a diary for patients so when they recover they can know their journey. If they don’t survive, feedback tells us that these diaries are a comfort to family.

We brush patients teeth, change their position, talk to patients who are unconscious. Explain to family, wash hair. Smuggle in a dog to visit, put a favourite teddy in the bed. Respect religion, race, sexuality. I have repositioned a bed to face Mecca and dropped off a valentine card for an elderly patients wife. We give the same high standard, skilled, excellent quality care to every person. Deal with all intimate procedures for our patients as well as operate ventilators, support organ failure with specialised drugs and machinery. Competent, skilled, highly knowledgeable, kind and caring group of individuals who are proud to be a Critical Care nurses.

It’s different now. We are in a growing storm.

Just fire-fighting to do whatever we can to keep someone alive, to try our best to help them beat this unrelenting deadly virus.

There are nurses to help who are unfamiliar with the ICU environment. The personal care is impossible. One nurse said to me “I don’t even know my patients names”

This is not our usual place of work. There is a back drop. It’s like being in a weird dream. We all have trouble sleeping and so many of our permanent nurses who come from all over the world – want to go home. They probably will after this is done. We are broken.

True to form – there is hilarity amid the madness. Nurses have a sick sense of humour. We are laughing and crying and support each other. We have offers of counselling but the nurses are too busy and their priority outside the environment is to eat, sleep and have a very long shower. One day some of the nurses had the names of pop stars written on their gowns rather than their own name. I didn’t recognise Beyonce at all, a large male cardiac ICU nurses I think!!

We feel wretched and exhausted and tired while at work, guilty when not at work as we know there are not enough staff with the patients. Nurses work extra days. If I am not at work, I am coordinating staffing, rushing through temporary staff. Arranging ID cards and PC access. Ordering supplies, planning the opening of new make shift areas and procuring new equipment and talk to overwhelmed nurses.

I walked through one of the ICUs a few days ago and blew kisses at the nurses I know & recognise beneath swathes of fabric, plastic and paper. Possibly I didn’t know them but they got a kiss anyway! Today I received a text message from one of the Italian nurses. “Please come by and send me flying kisses again”

The level of anxiety increases immeasurably each day. Often too traumatic & surreal to talk about what we see and do. It’s particularly tough for the junior staff who work day after day expected to suddenly lead & guide staff from other areas.

We live a parallel life while others take the quarantine art challenge, plan Easter egg hunts and are bored at home. We continue on and on and on and still more patients arrive. They feel ill and scared. One man said “please don’t let me die”

Thank you for your support. Keep it going. I think nurses will need support way beyond this time. Every card, email, text, WhatsApp makes a difference. The support I

receive powers me on to support my incredible team of critical care nurses. If you know a nurse- send them a message or drop something on their doorstep.

This is a different way of nursing. Unchartered with no end in sight.

There are many NHS workers, some unseen who are struggling. The mortuary staff who have an endless stream of dead bodies to store. Our mortuary is full. The lab technicians who have to process the stream of swabs as well as their daily testing of blood & specimens. Our technicians servicing & cleaning the ventilators -some are over 50 years old and repurposed. The pharmacy- keeping up with the supply of drugs required. Recruitment who are processing new, redeployed & temporary staff. Many NHS workers. The nurses and doctors on the front line and our entire team. I share your donations & messages with them too. A junior doctor told me “when this is done – so am I- no amount of money could make me stay” she then asked who sent in the delicious figs!

I appreciate all the messages. I can’t always reply as I am working or don’t know what to say or I am just totally exhausted.

Keep safe, keep smiling and never underestimate the importance of staying at home at this time.

 

 

Further update from Anthea on Tuesday 21st April – Covid19 initiative supporting our frontline NHS workers

 

Your messages and words of support continue to warm my heart and feedback indicates that you want to learn of the reality from the stark coal face. The front line.

A war without weapons -One of our doctors who worked in Afghanistan mentioned that he feels the “dramatic level of trauma” is somehow worse than what he experienced out there.
This monster is worse? This Covid war has an unseen enemy and our dwindling supply of PPE supposedly protects us.
On Sunday I cared for a group of patients in a makeshift & cramped ICU on Brodie, usually a Neuro-surgical ward. Cables trailing along the ground, monitors balanced on top of ventilator and the emergency oxygen supply for my patient was attached to the bed of another patient with roles of green tubing that looked like a garden hose hanging off the end of the bed -in this non ICU.

The PPE is suffocating. It’s hot, it’s tight.

I have a cut above my left ear from the mask elastic. We have to shout or we cannot be heard. At one point I felt an overwhelming desire to break free and rip it all off. To lift my visor up and breath. My nose was blocked, my throat was sore- but then an alarm went off. A patient became unstable and I was distracted.
This war requires resilience,stamina and bravery. We are operating outside of our normal systems. It takes time to be a skilled professional in the Critical Care setting and suddenly we are catapulted into this strange & new space of Covid rage.
One man died. Age 60, apart from being diabetic he was a working husband and father. Myself and a junior nurse held his hands as he died, we spoke to him and the photo of him at his daughters wedding last summer, I tucked into his hand. There were no curtains around his bed, no family with him. He was another Covid victim, snatched from life. The junior nurse had tears running down her face “this is not how it is supposed to be” she said. I spoke to his daughter on the phone and could hear her pain as I tried inadequately to describe his final moments and reassure her he was not alone when he died.
He had been sedated. It is hard for the patients who are conscious as they cannot see our faces. I hope they can see us smile at them from behind our mask. We touch their face and hands so they feel safe and we will do all we can to help them through this.
One patient I recognise as one of our own nurses who refused to be ventilated at first as he was scared. Now I am programming his ventilator, giving him medication as I look into his familiar face. Happily he is doing well and I hope will make a full recovery.
A patient who was ventilated for 21 days left Critical Care and had been proned for much of the time (nursed lying on his stomach to improve oxygenation) As he was wheeled out, staff lined the corridors clapping and he smiled, waving his arms in victory. A fantastic moment that we shared. Patient & NHS staff-united together in success.
Another patient with pink gel nails who’s length of nail growth demonstrates the passing of time. I am sure she would be horrified to see her nails this way.
We are shattered and do what we can to ensure we all have space to shed a private tear or have time-out to eat & drink.
Hospitals always seem to be designed with only a spare inch of space. The walls are scarred from the beds and trolleys crashing into them but the genius who designed the Atkinson Morley Wing added a large balcony. We can eat hot lasagne provided by CriticalNhs which is a welcome comfort food and just for a moment, we sit with our face in the sun and feel like the world is normal again.
The grey, blue, green, white stainless steel shades we see are suddenly peppered with Liberty print, orange hedgehogs, Laura Ashley chinz, purple stripes and polka dot hair covers, sewn with love and donated by the wonderful community who support us. There is quite a fashion trend for the many nurses who look like Amish women with their hair covered with a cloth cap. The Trust tell us that these are not required as PPE.  It doesn’t matter, we love them and we all wear them. One of the male runners wore a pink cap with dancing kangaroos on.
I received a text from a Portuguese nurse “ I need some chocolate, a Coke and a new hair cover. Is there a pink one?” I was able to fulfil all 3 requests!
We are brilliant and to quote my daughter who I have had the very great pleasure of working beside said.
“The nurses are beautiful, hilarious, tireless heroes”
I don’t know how this will end but we look forward to that day. Desperate to hug someone – that’s what I miss.
Found one of our young nurses in the changing room – sobbing. I cuddled her as she she cried wondering what hideous thing she had just experienced. She calmed down and I held her tight and after a few minutes she simply said
 “I miss my mum”
For now- this is our normal and we are adjusting and have new protocols in place and a new way of working until we have won this war.
Some of you asked me to re send this link  Please take a look at CriticalNhs on Facebook or Twitter. This truly fabulous team created by Niall & Janneke after an email from me requesting biscuits for nurses. Their ongoing support and the support of so many friends, neighbours and far reaching community has been phenomenal and is supporting NHS staff through this war.

Further update from Anthea on Monday 27th April

 I am a marathon runner. The sheer exhaustion felt as running those final meters to the finish line is a similar feeling to the end of a shift on a Covid ICU – minus exhilaration and the smile on my face but the crowd support and the kindness of strangers is the same.

Today a total stranger, connected with another stranger though the new and amazing community network fired up by an email from me asking for biscuits @CriticalNhs.This stranger connection resulted in one of my lovely European nurses being lent a flat to live in for a few weeks. No rent, no bills. Just a set of keys and the wifi password. What’s the catch? Absolutely none. Only the unconditional respect for Critical Care Nurses.

I am astounded by the generosity and ongoing, unfailing respect and gratitude for NHS staff since we left our old world and entered this new one. Thank you seems not enough for the endless stream of offers of help I receive. A “stranger” friend said “you need anything, you just ask” and I did ask and he did help.

It is quieter now but a level of crazy still fills the air. The Trust have put efforts into staff wellbeing, providing hubs to relax in that offer hot drinks and refreshments. Sadly many of us are still too busy to pay a visit but I definitely plan to and there is “real coffee!”

I miss the old way of working. The familiar spaces and machinery. I knew where the syringes were kept, where we keep the attachments for the ventilators, the property book and where we hide the keys to the cupboard.

Yesterday I didn’t recognise a friend in PPE and when she spoke I couldn’t hear her as my Hazmat suit covered my ears. My FFP3 mask had pushed up my glasses so I couldn’t see her and my voice was muffled through the visor so when I spoke to her she couldn’t hear me! We did laugh and bump elbows.

How I took for granted our cool, navy, cotton scrubs and seeing our colleagues faces?

The tide has changed direction somewhat. The resilience of staff has blossomed and we are settling into our new normal. We have some empty beds and less admissions. We are discussing our hygiene regime once we arrive home after work, bargaining with each other for various cotton scrub hats, swaps for a various colour or design. The mantra of “whats for lunch?” starts from mid morning but none of us want to relax as the  invisible monster can rear its ugly head at any moment.

I have not cried at work for years. We all take a private moment when sadness overwhelms us or if we identify with a particular patient, but yesterday I felt a deep sadness that stayed with me all day. I cried in the office on my lunch break worrying our lovely receptionist. Then came home and cried in the shower and cried again. I had a large glass of wine and cried some more.

My patient was dying. I pride myself on my end of life care but I had never imagined taping my iPhone to a drip pole with Elastoplast and angling it with a nappy so the camera looked onto my patients face so her husband and children “could be with her” as she died. It was the best I could do but far from good enough. The iPad intended for this use was too complicated to set up with Skype so in order to connect the family as soon as possible, I had to make do. Usually families stay with a patient when they die, hold their hand, lie next to them, brush their hair. This felt so wrong & crude, deviating from protocol while creating a make-shift intimate forum.

This woman should not be dying. She should be at home nagging her children to do their homework or brush their teeth. Discussing with her husband what to have for supper. Normal Mum and family stuff.

My mood was lifted early evening when 3 junior nurses banged on the glass door waving at me “Mama Anthea” I could see they were smiling beneath their masks. I am always struck by how these young woman have immaculate eyeliner at the end of a shift. A passing doctor gave me a wave too- we all look out for each other.

This pandemic is straining our health system. There are debates about PPE. Jigsaws are popular again. We clap on Thursdays, children make rainbows, neighbours chat to one another.

This is a strange time requiring resilience, strength and hope.

We can only do our best and the staff I have the privilege of working with are doing their very best and so much more. We have many staff from Europe, India, the Philippine’s and from all over the world. These dedicated and fabulous people help hold up our health service.

We do have the strength to keep fighting this battle.

We will go to work, you stay at home.

 

 

Further update from Anthea on Monday 18th May 2020

The best rendition of the Mad Hatters Tea Party was when we yet again relocated 16 patients so another one of our ICU’s can be deep cleaned.

There is a degree of madness in transferring the kit and caboodle of a Critical Care patient. It takes many staff members bumping a bed down the corridor into the lift with the over -sensitive automated doors opening and closing while drip poles and the patients cot sides and other paraphernalia become jammed.

The lift alarm screaming while brute force is required to propelle the bed forward over the lift threshold which is never exactly the same level as the floor you have alighted at!

All done, we then ate delicious home made raspberry & lemon cake courtesy of “The Jam Tarts”

Long term patients improving and leaving the ward after a precarious and stormy Covid journey is always heart warming but there was not one dry eye when a patient left Critical Care for the ward after a full recovery. A man we thought would die despite our best care. He was wheeled out to a standing ovation from ward clerk to consultant – he “high fived” as he passed. It was magical.

Our new normal has settled, we are adapting our non ICU. The “can do” staff have devised new ways. A vomit bowl has been converted into an iPad stand (since writing this, we now have a fabulous gadget to hold them in place)Beds manoeuvred to create the space we need to house all the machinery required. The Weetabix stash has been relocated and ventilation tubing and filters are in their place in perfectly labels boxes. Nurses are ingenious and practical.

Despite Covid-19, Critical Care still admits regular patients into our green zone. A teenager who drank too much at a party (despite lockdown) the elderly woman hit by a car, a brain haemorrhage in a young man. A patient with a burst appendix, an overdose, asthma attack, a cardiac arrest, stroke, motorbike accident, a fall downstairs or off a roof. The many individuals who arrive at our door to be fixed, cared for, who recover or not. St Georges is still open for business and these patients can be cared for in a safe Covid free space.

Since the war began our head of nursing and matrons have stayed all night on occasion to plan and ensure we have supplies and safe staffing levels. Doctors who do not work in critical care have learned new skills, cleaners have to don full PPE to empty a bin or clean the floor, the porters who transfer people, equipment, documents and bodies to their next destination.

NHS staff are super heroes fuelled by the compassion and support from all of you (and cake)

One Spanish nurse finished her 12 hour night shift, removed her PPE, her face lined from the mask but with intact red lipstick that matched her scrub hat “but of course” she shrugged when I commented.

At the start, in March when the floodgates opened there were criteria set for who should be admitted, who should be palliated. We had to ensure there were beds for those who needed them. We have space now.

I recall a conversation with a woman who had a poor medical history and tested positive for Covid-19. The consultant asked in the kindest way, Did she want to be ventilated? Did she want CPR? What level of medical intervention was acceptable to her? It’s a tough conversation to have but so much better to talk with the patient directly so should they deteriorate, we know what they have chosen.

This woman wanted to discuss this with her sister, know she would never be in pain and she asked that her niece take care of her cat.

A DNR order was instituted and discarded once she improved and was discharged to the ward.

Covid patients surrender themselves to us. It isn’t just Covid-19 that attacks them. Perhaps a cytokine storm which overwhelms them, a bacterial pneumonia, a bleed on the brain or mainly- multi organ failure.

The nurses are there for them. We move a bed next to a window so the patient can see the trees. A patient with learning difficulties watches Peppa Pig on a loop. Mouth swabs are dipped in orange juice. A senior sister on night shifts, always gives a foot massage to a particular patient to help him sleep.

It is calmer and quiet but the cracks are beginning to show.

“My head spins, my heart pounds in my chest and I can’t breath”

“I have nightmares every night”

These nurses are now receiving counselling but I am alert for others that need support.

We care for each other, laugh together, cry together and there is nothing like a full on PPE hug. Hugs are a basic human need. I miss hugging my non work friends & family.  Nurses are lucky. We get more hugs than anyone from someone who totally “gets it”

Don’t forget us. This has not gone. If the predicted surge doesn’t happen we are very, very lucky but if it does happen we know how it feels to drown- this time we have a few life jackets.

For now,

We focus on recovery and rehabilitation for some patients or enable a good death to those who will not survive.

I hear my emails are spread far and wide and people ask if there is anything they can do to help.

There is.

I challenge you all at this time with these 3 things to help us and help you.

1, Talk to your family about your end of life wishes.

2, Talk to your family about organ donation.

3, Always wear a helmet on a bike. If you are on a family cycle in a park and one of you cycles downhill fast and your chain snaps and you hit the ground head first, at speed. A helmet may just make the difference.

No helmet and there may be one less person in your family.

 

Further update from Anthea on 30th May 2020

There are not enough Critical Care nurses. We have so many nurses from other areas who have stepped up and are stretching themselves way beyond their comfort zone, their knowledge base elsewhere. Senior staff have had to adapt to a different way. A dental nurse, a dementia specialist nurse, a nurse from theatre or endoscopy. Competent in their own area but suddenly removed from their context. Having to learn on the hoof and my shattered team need to direct, guide and supervise these new staff. Mostly we embrace this but it’s exhausting for us all.

I take charge and search the PPE masked faces to spot my own familiar staff. Yesterday the result of displaced staff had disastrous consequences.

I am sleeping so badly, we all are. Braced for the next punch. I have learned so much of the aetiology of Covid- it’s clues, it’s progress and supportive treatment. Having seen a multitude of different reasons for admission to Critical Care over the years, we are fast learning about a new disease process unfamiliar to us- in that respect this is easier. All the patients have the same issue, similar symptom, similar care and treatment. Unrelenting. Less madness but the patients are still arriving and there are patients who have been with us for weeks, but we are coping.

A patient left our ICU last weeks free 40 days, for many of those he was ventilated and proned. “No clapping” he said. It was all too overwhelming. This man said “Covid didn’t get me, I got Covid” We have this pinned up on the wall in the red zone. We all have “battle fatigue” the space to think is now available and we are beginning to unravel.

Sadly I have been a victim of the “crying thing“ again. It’s actually a relief to cry. I was in a safe space with my family and my son- unprompted gave me a kiss – this never normally happens!

I am not sure if we will have a surge like the first wave that hit but this virus keeps revealing it’s victims.

Patients who cannot speak English must be so scared. We rely on a member of staff speaking the same language. One woman was on holiday in London when Covid struck her. It will be a long time until she returns to her home in Poland.

Our world feels broken. There is an economic downturn. Shops are boarded up. I cycled through central London last week now owned by runners, cyclists and walkers. The streets quiet but the parks are crowded as if there is a festival on.

Behind the doors of St Georges we plan, devise new protocols and weekly this changes. We have adapted, we navigate the obstacles, we continue on, mustering up fresh energy and perspective  Frequently moving patients, opening new areas, disrupting staff. Clean areas, dirty areas, Covid zones.

The highlight of the 9th clap was a trip to the helipad at St Georges. We clapped for front line workers and the BBC who filmed us – an amazing experiences to share with my daughter Claudia working on Critical Care at St Georges as our temporary ward clerk with her politics and IR degree on hold. She will return to Bristol in September with an unexpected life experience under her belt.

We remain challenged by a different space at work. Nurses are resilient, as a senior consultant pointed out – we don’t complain about the work. We complain about the lack of parking and office space.

For now things have improved but we wait and see. I am emotionally robust but this has hit me hard. The NHS is usually stretched to the limit usually but now has to cope with the arrival of patients who have been “hanging in there” at home. They are really unwell and it’s not always possible to fix them. Reluctant and scared to come to hospital to be treated and there is no cure.

Please remember- as your world starts returning to some semblance of normal. It’s not over. Please keep washing your hands.Behind the orange brick walls, we are still fighting this. Our incredible, unbreakable and fabulous team shine brightly.

Further update from Anthea on 8th June 2020

A few weeks ago the discount at the  local butcher was 20%. I was smiled at when I skipped the queue at the supermarket. I felt emotionally warmed by the Thursday clap, especially when leaving the hospital after a day at work. Ambulances would flash their lights and sound their sirens, staff and patients and local residents would cheer.

 

Not now. 20% is 10%. I get glared at when I produce my NHS ID at the shop entrance as the queue for the next individual has now become one person longer. People have stopped clapping, already slowed as 8pm may interrupt the evening meal, bath time or a Zoom call with friends. Lockdown seemingly lifted. People distracted by the need for a holiday or hair cut- fed up -ready to get back to their abandoned life. NHS staff now spring to mind when we are needed. When you want a doctor or end up in A&E with a persistent cough and difficulty in breathing or another minor or serious illness, disease or accident. But-that is ok, perhaps we should move on and get back to normal. We are appreciated by the majority of people who are in fact our patients -past, present and future.

Inside the Covid bubble at work the PPE is plentiful. There is a system in place. The NHS love to have a process. Staff know where their new work place is. We are organised. Shelves are labelled and cupboards tidy. The Covid ICU’s run parallel to the regular ICU who care for the usual flow of non Covid patients. Elective surgery has re-started and the small steps of recovery are beginning to emerge.

We have liason nurses allocated to update families but now I telephone the family myself to directly update them, pass on a message as I have time and to learn about the patient I have been caring for. It’s lovely to pass on the message that the garden at home is looking great, the roses are out, or Sarah has had a baby boy. Recovering patients without visitors need the minute detail of home. Often too tired for a FaceTime call.

Mentally, we are not the same as we were at the beginning of this hardest fight. Our bond is stronger. The level of teamwork is incredible and we have slightly gone “off piste” with some pre-existing policies that are no longer relevant, devised before the madness or created by someone disconnected from the truth. We swerve the red tape and have devised practical solutions to some of the obstacles Covid presented us with.

A bottle of champagne cracked open with close senior colleagues in a back garden in the sun was the absolute best therapy- to let rip with  friends who understand. To be in charge, to lead the day to day is tough. I am senior. I am supporting junior staff, supporting strangers who are “picking it up”

I am used to working with a skilled, knowledgeable, experienced medical team or teaching and mentoring a junior team within a purpose built environment, not working with staff unqualified in the critical care speciality who I am grateful for but at the same time shocked, worried and frustrated by as learning on the hoof in such an area is far from ideal. There is skilled witchery involved in optimising a persons blood gases by fine tuning their ventilator settings.

There is a glorious madness to our days. Getting caught up in a gown which is tricky to don in a hurry. My waist tie is always in a knot. Masks tangled in hair, glasses and visors. Clanging heads with a colleague as we temporarily underestimate the visor space between us. Having a conversation with a stranger who turns out to be one of your favourite people once the mask is off! Mishearing “do you want to go for a coffee?” as “do you know where the mop is?” Nurses are loving, physical people and we work in such close proximity in sometimes intimate and emotionally challenging situations. We hug each other a lot and I am seeing nurses kiss each other – how lucky I am to have so many hugs and a closeness to my colleagues, many of whom are my friends.

A recovering Covid patient -when admitted to hospital- an intravenous drug addict who also smoked crack cocaine. He is recovering and will be discharged to the ward soon. I asked if he would get back on “the stuff” again?

He answered “Nah! That’s a mugs game- I am done with all that. I think you could say I’ve been given a second chance. Bloody good thing I got this Covid bug!”

Covid bug?!!

Fantastic that the enormity of Covid has had such a positive life changing impact on his frail war torn body.

It’s true this affects the BAME group of people and those who have a high BMI or who have hypertension (elevated blood pressure) or diabetes. However they are definitely not the only ones. Last week we had a young Mum who just had a baby, a colleague working at another hospital cared for a young, fit marathon runner who sadly died. I have seen or directly nursed previously fit & healthy people of all ages. A scientist, an actor, a musician, a nurse, food taster, a father, a gardener, a teacher and a member of staff from Topshop. Anyone can be affected, just regular people,anyone can die.

Those admitted to ICU for organ support, may be mended  by our brilliance and newly acquired Covid knowledge. In fact we are seeing more and more people survive – we are getting better and better at this. We now know what Covid does to a persons body and how we can support and treat their symptoms.

It is better but it’s still here. We are still admitting Covid patients. In March when I came home after a 14 hours day (should be 12, paid for 11.5) when two out of my six patients died, when my phone was strapped to a drip pole, when my support nurse kept crying, where my ears were ringing as I felt so dehydrated. My bladder full and my heart heavy. That has abated. Still bruised from an experience I thought was not possible, concern for my  colleagues, frustration at the lack of many things. That remains.

Apologies for grammatical error. My account flows. I started this to thank you, then to inform you and now in some strange way, it helps me to write it. A friend said my written error gives it all a “raw & immediate authenticity”

Thank you endlessly for your support. To my friends who tolerate my silence, understand my need to complain or cry or say nothing but deliver a treat or message regularly without receiving a reply. The waves and kisses blown by friends I pass while on a run. Usually a positive person I sometimes feel angry but am not sure why- often minor issues. This week I felt mightily annoyed that a qualified Critical Care nurse I have worked with for 15 years had the wrong size scrubs because a “helper” had been given the last pair in her size. I need to be calm, take a breath. One day this will be over.

We are prepared for a surge if one happens and we quietly and tentatively are trying to get the hospital back to some sort of normality. Freshly deep cleaned, freshly stocked and waiting to go.

This week Claudia spent time looking for an elderly mans property, retracing his journey around the Critical Care areas. He was low in mood and missing his wife. She eventually found it and he was thrilled to be reunited with his long lost dentures and electric shaver -untroubled that his phone and wallet were also found. Such joy on his face.

Thought for the day.

Last Wednesday three nurse spent two hours combing, detangling, de- matting the acquired dreadlocks from weeks of being bed bound, the long hair of woman with thick locks, coated with sweat, blood, dead skin, spilt sticky medication, milky feed, vomit and saliva.

Washed, conditioned, tangle free her luxurious hair shone.

Nurses are superstars in their own quiet and unseen way.

 

Further update from Anthea on 22 June 2020

 

I love to run. I ran a half marathon just before Covid took over my life and I am just back to running longer distances. Running clears my mind and it feels great to escape. My therapy and my time alone to re calibrate.

I am concerned for our mental health – anxiety, fear, exhaustion and insomnia. Everyone seems fine but we all feel the same. We are not ok at all. I have taken numerous calls from broken nurses who need sympathy, support and gratitude. A friend called me having had a panic attack. Fine at work but once at home felt “displaced and scared” We are offered free counselling and many staff have seen our lovely counsellor but it’s hard to describe the war we have experienced without speaking our medical language and how do we explain? One nurse told me she “plays it down” during these sessions as our memories are too brutal to share. Our nurses don’t tell their family the truth in case they worry. A friend told me that he doesn’t read my emails as they are too hard to read- I did point out it was actually too hard to do!

Patient wise it’s better, seemingly no surge yet. Our Covid areas only have a few Covid patients remaining who have been with us so long they have tested Covid negative. Yesterday my area – General ICU looked almost back to normal. Police guarding a patient under arrest, patients going to and returning from theatre, physiotherapists helping a patient walk -non Covid, regular patients being cared for by our own home grown and magnificent critical care team.

Discarded blue gloves and disposable masks now litter the streets. Health Care professionals find this absurd as these flimsy masks will not protect us; they will damage the environment, litter the streets and give a false sense of security. I imagine them getting dropped onto the floor on trains or toilets and then worn against a persons face or kept in a pocket, warm and moist with crumbs and saliva -attracting what they are supposed to repel.

Staff are required to complete a complex risk assessment form. We already risked our lives, without any choice – it’s a bit late now!

We have spent enough time in PPE,  I feel disinclined to wear a mask on the street. I saw someone in Tooting lift his mask with a gloved hand to spit on the ground. He than scratched his ear and replaced his mask!

Support bubbles, BBQs and social groups are unlocking people’s lives. There are glimpses of normal all around and it feels good. One nurse had a beer outside a pub. She sent me a message “it felt so, so nice”

We are the Corona virus heroes. I have never been particularly militant but I hear we will receive a medal from the government. That’s nothing at all. We need more, so much more. Even a significant pay rise would not help entirely. We have been smashed. I am strong, robust and laugh a lot but I will never be the same again. I will always carry a part of this with me as will the many superb people from our clinical director for Critical Care to our cleaner. We all played a part.

The hospital or “Trust” seems to run separately- in their own Covid bubble, many working away from the reality- safely at home. The Trust leading with social distancing signs and “please wear a mask when entering the hospital” front desk staff yell at anyone entering the building without a mask gagging them. Regular communication bulletins are sent that contradicts the last one- endlessly trying to keep up with the government and health and safety guidelines, invariably too late while apparently supportive they are actually emotionally distanced and naiive about how it really is for those in direct contact -touching the patient.

How can they possibly know or understand?

Social distancing cannot apply in such a space. The contact with patients and each other is incredible and being at work with those whose have shared so much is like being with family and with that, some strong emotional bonds have developed.

Pecan slice, homemade cakes & biscuits  and those sausage rolls.. are a lovely treat that keep appearing and the Trust continue to supply crisps, bottled water, decent biscuits and boring sandwiches.

I try and spend time chatting, to express our appreciation to which ever lovely person drops off a delivery of treats. The fantastic team of temporary ward clerks helping me, waited patiently (uni students including -Claudia) I apologised for keeping them waiting prior to their streamlined delivery of sweet treats to our Critical Care areas. Jerome said “don’t worry, it reminds me of waiting for my Mum after church!” He made me laugh so much.

We continue, Surge or no surge, surgery is backed up and those who avoided coming to hospital and have deteriorated at home now need us. It’s always busy, always fast paced, always excellent and frequently hilarious. Critical Care delivered by the most awesome gold standard team.

It’s all ok and it’s not ok at all.

Today a patient said “ I was in a restaurant in March having lunch with my mum after a long ride on my horse. I had a cough and felt tired. Now it is June- what happened to me?”

Thank you to my community and ever expanding circle for being there for us and for not stopping -just yet.

 

Further update from Anthea on 28 June 2020

The best part of Covid is the strong bonds we form and no amount of “tutting” from a non clinical member of staff when seen in our Critical Care space hugging our colleagues, makes me step back a couple of metres. It’s a risk versus benefit thing. Who knew hugs were needed for survival? But they are. They have supported us through the death of our patients, the wretchedness we feel, the isolation and exhaustion. We are brave and strong and emotional and pay no attention to social distancing as we have all been wallowing in the same petri dish for months.

I connected a ventilated and awake patient to the haemofiltration machine. I needed forceps to unscrew the caps attached  tightly to the catheter in her neck. My lovely patient held the clamps and passed them backwards and forwards to me as I needed them – my invaluable assistant supporting her own care! The bond we develop with our patients is outstanding- Critical Care patient turn over is usually fairly fast but the Covid patients are with us for weeks on end and we get to know them so well.

A Tamil speaking doctor translated for a 60 day resident on Covid ICU, he was low in mood and we were finally able to learn from the Tamil translation that “hospital food tastes like shit!” A quick call to the patients sister remedied the situation. A few hours later she dropped off the home made chick peas curry and the rice cake he longed for.

Last weekend I felt close to tears the entire day. In order to permanently double our Critical Care capacity we need to recruit more staff – I run the nurse recruitment and care for patients and take charge and I just felt overwhelmed while trying to swerve the ever emerging PTSD.

Nurses resilience, persistence, and at the same time gentleness, has been an example to humankind. Staff are starting to plan trips home and I have set interviews for promotion before they go, in a hope they will return. We invest time and finances educating and training Critical Care nurses. NHS England say we must increase our foot print – our Critical Care beds to serve London better but the meetings and planning and meetings go on and nothing is decided or agreed or “signed off” all those people working from home, the Microsoft teams meetings, finance, operational leaders and other directors of this, that and the other who decide how we should run our hospital which despite everything runs itself by the medical staff.

On Tuesday evening I was blindsided by love. My junior team arranged a surprise and showered me with gifts, cards, claps and thank you for being their Mama Anthea. I was for once speechless. Overwhelmed by the very best hand-picked by me – a team of total superstars. A room of nurses I employed who I am so proud of.

One of our senior nurses, my colleague and friend who has been an inspiration and support, leading and educating -left her last shift on Covid ICU to clapping and cheering by staff who lined the corridors, the same as we did for our patients when they left our Covid unit having survived. We all cried, especially Chris

Clapping has a whole new meaning for me now.

I have been wondering if I should stop my emails soon or wean them as we weaned our patients from their ventilators.

On 26th June 2020 the last patient left Covid Critical Care. Our red zone now empty. Abandoned. After 3 months and 1 day. Not one Covid patient requires ICU care. Spaces are cleaned and equipment returned and our incredible team, created overnight 4 months ago ate pizza together -reminiscing. I almost felt sad, tinged with relief – this time had ended. Our WhatsApp group brimming with comments of camaraderie. Catapulted back to our regular place of work, temporary support staff discarded. So weird, so strange. Our new normal now gone.

One of our support workers said when she started working on Critical Care she boarded the Covid express train.

The train has arrived at its destination now.

We treated so many patients on Critical Care and lost almost 300 but 992 survived- some against all odds and many of those have now gone home.

Will the Covid express run again? Is the enemy hiding behind the wall ready to fire again?

We wait,

We are invincible.

 

Further update from Anthea on 4 August 2020

We marinated in Covid for such a long time and the debrief sessions we have each week run by one of our fabulous Team Leaders are a chance for us to wallow in our memories of our trip to outer space. The curve ball that tripped us up. From cleaner to consultant we all have our story to tell from a different perspective. A senior consultant said

“I am old, fat and hypertensive and I was really scared when I came to work”

It’s cathartic to know that we all feel the same. Can’t sleep, Covid-lag I call it. This week the most I slept was 5 hours, mostly I sleep 3-4 hours per night. I don’t feel tired, that Adrenaline rush that I try to burn off when I run. Scratch the surface and we remain a bit emotional. It feels like a dream. The younger nurses  are like a bouncy ball and are on the way up. I still feel on occasion as do other senior staff, we are still holding our balls under the surface of the water.

The future is complex and uncertain. We cannot predict what will be next. We are not on the frontline anymore. The mask wearing, hand washing, social distancing new population are on the front line, they control our future.  We are on the back line, ready to catch you if you fall.

An Irish nurse said It’s ok to feel weird and perhaps it is. My axis has been tipped. That imaginary line around which things rotate or a straight line around which things are evenly arranged.

Elisabeth and I have just watched an 8 part series on iPlayer. It was a welcome escape and my new perspective on life, my altered axis, enabled me to appreciate this superb British drama on another level. People are important as is love and friendship.

A young man hung himself. I spoke with the senior nurse for organ donation (SNOD) after his wife agreed for his organs to be donated. The senior nurse who is also my friend was finding it so hard. How do you support someone who has lost their husband in such a violent way? The father of her small children. Nurses do so much more than anyone understands and then even more on top of that. My friend had to tell the children that “ the doctors and nurses tried to make daddy better but they couldn’t so he died” There is no training for this, you learn it and find it from within yourself”  We went for a coffee together, we never get used to the heartache. You just find a place for it – this is someone else’s story and grief but if one day an individual looks back at the horrendous and traumatic experience of losing someone they love and a nurse made a difference,  that is enough. Messages I received during March, April and May showed me what a difference we do make to our patients and their loved ones.

Many Spanish hearts are broken. These nurses worked through Covid and they now go home to see family, a new niece or nephew, attend their school friends wedding, see an elderly relative, however, they must self -isolate for 14 days  on their return using their own annual leave or take unpaid leave. This makes me angry. I understand government FCO guidelines have changed but can’t we just support them? Why do we treat nurses so badly? They cancel their trip or they leave. One of them said. “I just want to hug my Grandmother, that’s what I want most” No pay rise, no real gratitude, no bonus, no support. We go abroad to recruit nurses, this is how we repay them after what they have done. I feel ashamed.

(Since writing this, a decision has made for our Spanish staff to follow government guidelines and self isolate but they will be paid and not lose their annual leave)

A patient collapsed at the airport, the drugs he swallowed wrapped in cling film to smuggle into the country had burst inside him. A man jumped from a motorway bridge to end his life and a woman chose to stop the treatment for her cancer. All patients on Critical Care, all desperate in their own way. Our medical team patch them up, relieve their pain and try and comfort their family. No salary can reward this brilliance.

The trajectory still heads towards normal, as normal as a day on Critical Care can ever be. We are actively recruiting new staff to train and mould into Critical Care nurses, some of these nurses came to help during the pandemic and are now drawn to the madness and our supportive team. If we surge we are already expanding our staff numbers.

The patients bathroom has been fixed. Days of tolerating drilling and banging and sticky paper on the corridor floor and voila! -a new bathroom that looks identical to the last one- minimal amount spent to refresh it and stop the leak!

(I told a friend and colleague that the sticky paper on the floor was to catch rats – she believed me “really?” She said. It goes to show that a  Critical Care nurse is not phased by anything)

I keep writing, I continue to receive positive feedback and in a weird way I enjoy it now. The crazy, funny glorious madness that is Critical Care.

Please please. Tell your family what you want if you die. Would you donate your organs? Do you want to survive no matter what? Do you want to be ventilated to prolong your life if there is no chance of recovery? Would you want CPR?

Mostly we are fit and healthy so this is not an issue but sudden illness or traumatic injury or as we get older…

Our family need to know our wishes – they rarely do. If they do, it makes it just a little bit easier

 

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